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Distribution of arterial lesions in Takayasu's arteritis and giant cell arteritis
Peter C Grayson1, Kathleen Maksimowicz-McKinnon, Tiffany M Clark
1The Vasculitis Center, Section of Rheumatology, and the Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
Insights
Takayasu's arteritis (TAK) and giant cell arteritis (GCA) share similar arterial lesion patterns, with subtle differences suggesting they may be part of a disease spectrum. Both involve contiguous aorta and symmetric branch vessel disease.
Area of Science:
- Vascular Medicine
- Rheumatology
- Medical Imaging
Background:
- Takayasu's arteritis (TAK) and giant cell arteritis (GCA) are large vessel vasculitides with overlapping clinical and imaging features.
- Understanding the specific patterns of arteriographic lesions is crucial for accurate diagnosis and management.
Purpose of the Study:
- To compare arteriographic lesion patterns in the aorta and its primary branches between patients with TAK and GCA.
- To identify distinct or overlapping disease distributions that could inform classification.
Main Methods:
- Analysis of arteriographic data from North American cohorts of TAK and GCA patients.
- Calculation of lesion frequencies in 15 large arteries.
- Application of cluster analysis and latent class analysis to identify disease patterns and compare classification models.
Main Results:
- Arteriographic lesions were identified in 145 TAK and 62 GCA patients.
- Both TAK and GCA showed contiguous aortic and symmetric branch vessel involvement.
- Distinct differences included more left carotid and mesenteric disease in TAK, and more axillary disease in GCA.
- Subclavian disease distribution varied by age and disease type, with asymmetric patterns in TAK and younger patients, and symmetric patterns in GCA and older patients.
Conclusions:
- TAK and GCA exhibit significant similarities alongside subtle differences in arterial disease distribution.
- These findings support the hypothesis that TAK and GCA may represent different manifestations along a disease spectrum.
Objectives:
To compare patterns of arteriographic lesions of the aorta and primary branches in patients with Takayasu's arteritis (TAK) and giant cell arteritis (GCA).
Methods:
Patients were selected from two North American cohorts of TAK and GCA. The frequency of arteriographic lesions was calculated for 15 large arteries. Cluster analysis was used to derive patterns of arterial disease in TAK versus GCA and in patients categorised by age at disease onset. Using latent class analysis, computer derived classification models based upon patterns of arterial disease were compared with traditional classification.
Results:
Arteriographic lesions were identified in 145 patients with TAK and 62 patients with GCA. Cluster analysis demonstrated that arterial involvement was contiguous in the aorta and usually symmetric in paired branch vessels for TAK and GCA. There was significantly more left carotid (p=0.03) and mesenteric (p=0.02) artery disease in TAK and more left and right axillary (p<0.01) artery disease in GCA. Subclavian disease clustered asymmetrically in TAK and in patients ≤55 years at disease onset and clustered symmetrically in GCA and patients >55 years at disease onset. Computer derived classification models distinguished TAK from GCA in two subgroups, defining 26% and 18% of the study sample; however, 56% of patients were classified into a subgroup that did not strongly differentiate between TAK and GCA.
Conclusions:
Strong similarities and subtle differences in the distribution of arterial disease were observed between TAK and GCA. These findings suggest that TAK and GCA may exist on a spectrum within the same disease.
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